I STILL DREAM OF ORGONON

Various and Sundry, 8/13/09

* E-mail asking me what my opinion about the current state of the health care debate is, and my response is: There’s a debate? Maybe I’m reading an archaic definition, but “debate” is not synonymous with “ignit bellowsacks at public meetings shouting stupidities to drown out discussion because doughy tearsquirter Glenn Beck told them to,” which is what appears to be going on at the moment. I’m sad for the Republicans, conservatives and others with actual, substantive objections to the current health care plan wending through Congress that a genuine debate is off the boards in favor of a strategy of uninformed tools making asses of themselves for the benefit of television cameras, but this is where that side is at right now. I will say, however, that when the whole of your health care debate strategy is to scream down any discussion at all, you’re pretty baldly acknowledging that you’ve got nothin’.

* Beyond that I have nothing at all of interest to say about anything in the real world at the moment. Hey, I was at a Worldcon for five days and had a day of travel and recoup on either end. It’ll take me a couple days to get back into the swing of things.

* Dipping back into the Hugos for a second, I’ve had a couple of questions asked of me recently, being a) when will I win a fiction Hugo, and b) am I now going to put “Hugo Award Winner” on the cover of my novels. The answers are a) Really not up to me, although I would like to win one, of course, and b) Not yet. I have two Hugos now, but neither is for fiction writing, and I’d need to have a fiction Hugo before I’d be comfortable plastering “HUGO WINNER” on the cover of a novel. I’m happy to note “Hugo winner” in biographies, jacket blurbs, etc, because why not? It’s true. But context matters. So as far as I’m concerned, still not on novel covers. Now, bear in mind, please, that what goes on covers is not always up to authors. I may not always get a vote. But when I do get a vote, that’s my vote.

* After expressing my fannishness about Montreal, I was asked if there was anything I didn’t like about the town. I wasn’t there long enough to develop a real deep negative opinion about anything, but I will offer this: No offense, Montreal, but your bagels aren’t all that. They’re different, I’ll give you that, and I did like them. But I think they were a bit oversold to me as omg the most amazing bagels EVAR, and I just didn’t feel that level of love for them. Please don’t hate me.

Ugh, yes, and the idiot-baiting seems to be making things actually worse. I’d like to see some sort of national health care, but based on everything I know the actual bills being proposed right now are pretty terrible. It seems like the job of the opposition would be to point this out and force the proponents to make things better, but instead the GOP is doing an ignorance-fueled misinformathon. So instead of getting something decent that a moderate like myself could actually get behind, it looks like we’re choosing between the status quo (which is terrible) and whatever the lawyers and lobbyists patched together (which is also terrible).

Yeah, there’s not really much serious debate when the other side is hyping idiocy like “death panels”.

And actually, the proposed new system would be much more like Australia’s than the UK’s. Australians I know who can afford it go for private health insurance, but those who can’t are totally happy with the public option, and are horrified by what passes for public care in the US.

The system as currently proposed has it’s problems, but the “reforms” proposed by the few opponents who’re not going nuts are just more of the same current system, and don’t cover anyone who’s not able to get coverage in the current system.

The truly whacked out thing is that it’s not like Obama isn’t known for trying to talk to the other side, but not one of the major conservative/republican spokespeople is trying to sit down with him and work things out. They’re all attack, all the time. And it’s sad. This isn’t a debate. It’s either an angry mob, or people cynically manipulating them for political gain.

Just so I’m clear on this…the democrats own the bully pulpit, write the legislation (which they can pretty much pass whenever they want) and can get primetime media coverage anytime but the reason we aren’t having a national debate is because random people at town hall meetings get up and scream for a while? They have all the power and yet they are also victims. Right.

On bagels, I would recommend Bodo’s in Charlottesville anytime anyone is down there. They are the exclusive breakfast food for all those Wahoos down there, and (believe it or not) the Caesar salads are an amazingfood for hungover people. Not that I was ever one of those while attending. Mom.

Also, on the baked goods front, has anyone ever tried the pretzel baguette at Whole Foods? Quite good. I may have it at my next gathering with yellow mustard… doesn’t look posh, but I bet it will be a favorite.

“but the reason we aren’t having a national debate is because random people at town hall meetings get up and scream for a while? ”

Except they aren’t random, and the getting up and screaming is staged intentionally to suggest a) there is more anger at the plan out there than there actually is and b) to drown out any attempt to have a reasonable public discussion.

So, yes, actually, when a group of people are actively working in concert to disrupt civil discussions of the health care issue in forum available to voters and constituents, it is a reason we aren’t having a national debate.

JesterJ @#13
My husband graduated from UVA back in the dark ages and frequently raves about a grilled glazed doughnut with ice cream. Probably not suitable for anyone’s diet no matter what kind of health insurance plan one has.

My point, really, is that we aren’t having a national debate because, from a purely pragmatic point of view, there’s no need for one. The democrats won a mandate from the voting public and can now do pretty much whatever they want. They really don’t need to convince people that they’re right.

As far as the “Death Panel” discussion goes, I think it’s an unfortunate and sensational name given to a topic that should be a legitimate concern. When the stated purpose of this legislation is to curtail healthcare costs, and the entity that is responsible for these costs offers advice to patients regarding their healthcare decisions, isn’t it reasonable to think that this advice will be geared towards cutting costs? Wouldn’t most people who get insurance through their employers be concerned if their employers started giving them advice regarding their health care? While I think the rhetoric on the right has gone too far in some cases, I think it’s naive to believe that the government will be a completely impartial observer when it comes to giving people advice about health care or health insurance.

I tend to stay out of these types of arguments because I think (D) and (R) are essentially the same party with minor differences that they blow way out of proportion to SEEM different, when it fact, it’s the same blue blooded top 2% of the population that’s been in control of our country for 150+ years.. Having said that, I think the idea that a national debate is required in order for legislation to be passed is a pretty fairy tale but no more than that. When was the last time a Congress (controlled by either party) required popular support to actually pass whatever bullshit they are calling “legislation” at that particular time?

Why yes, I suppose I am a tad jaded, I’m a product of the system that made me..

My point, really, is that we aren’t having a national debate because, from a purely pragmatic point of view, there’s no need for one. The democrats won a mandate from the voting public and can now do pretty much whatever they want. They really don’t need to convince people that they’re right.

You really don’t have much idea how the republic actually works, do you? I mean, in perfecto-United States, that might happen, but in our messy and actual world, that’s akin to saying something along the lines of “Well, hey, parents are in charge, so they can just tell their children what to do and the children will do it.”

Wouldn’t most people who get insurance through their employers be concerned if their employers started giving them advice regarding their health care?

If by a “staged event” you are suggesting that these aren’t genuinely held beliefs then I would like to know how you’ve ascertained this. Not to compare the two in terms of importance, but Rosa Parks sitting in the front of the bus was a “staged event” as well. I don’t think this has any impact on the importance of that event.

Indeed. Mercifully, I don’t get TV reception. (I think occasionally about getting cable again. And then I think: WHY? And I never have a good answer.) So I don’t SEE any of the healthcare melée. But reading and listening to the radio provide quite enough idiotic vitriol, even so.

I start by thinking, how could anyone possibly be idiotic and ignorant enough to fall for tactics like this? And then I think: Whoa, wait a minute, how could anyone possibly be ignorant and idiotic enough to BEHAVE that way and SAY those things? And in PUBLIC? Are they simultaneously drunk, high, =and= lobotomized? And if not… then is there any other explanation that makes sense for such repellant and irrational behavior.

Oh. Wait. Of course. In a system where hospitals charge $3 for a single aspirin, and throwing up recently cost a friend of mine $1200, there’s SO MUCH MONEY at stake for people profiting from the current health care system that they and the politicians in their pockets will do or say ANYTHING to prevent changes, let alone reforms.

@David I’m not saying that this mandate means they will do exactly what everyone who voted for them wants. It means they don’t have to convince the other guys that they’re right. Frankly, I’m astounded that they haven’t been able to pass this legislation already. I’m not sure what’s standing in their way.

To continue my previous thought, if the Obama administration wanted a national debate, I’m sure some opposing viewpoints would have been presented during the ABC primetime special on health insurance reform.

“Even so, I do find that they’re getting a bit more media attention than they deserve. And I’m fairly liberal.”

I have no disagreement with this.

Adam:

“If by a ‘staged event’ you are suggesting that these aren’t genuinely held beliefs then I would like to know how you’ve ascertained this.”

In my case, at least, such was not the suggestion. However, neither are these “random” people, either — In many cases they’re going in with the intent to disrupt the event in order block actual discussion.

Err, only, they were the patriotic non-organized peaceful non-disruptive eloquently-spoken “good” guys, right. I can’t ever seem to remember who we’re supposed to hate for expressing opinions and who we’re supposed to worship.

And I do agree that the response to the proposed health insurance reform should be much less screamy and much more thinky. In this way, I think the nature of the response (or at least the perceived response) has been adversely affected by the media.

Adam @ # 17 – As far as the “Death Panel” discussion goes, I think it’s an unfortunate and sensational name given to a topic that should be a legitimate concern.

It’s not a legitimate concern as presented. Seriously. Nowhere in the first world where they have public health care as an option are there panels that sit around euthanizing people. If you can’t stand that end of life care is being presented as an important part of health care, you’ve got no place in the conversation as a rational person.

Having recently dealt with end of life care for a family member, I can tell you from first hand experience that it’s better to discuss options of palliative versus life extending care, when life extension is just going to prolong agony. Because not talking about it is stupid, and cruel to all concerned. And that’s all the proposal does. it introduces a conversation about end of life care as a part of health care. Better hospitals do this already. Worse hospitals don’t.

And turning that into a political football, which is what the Republicans are doing, is vile.

He said some ways of looking after those with chronic illnesses, including forcible or ‘peg’ feeding of Alzheimer’s sufferers, were degradpulsorying and painful. ‘I am certain no one sets out to be cruel, but our treatment of the elderly ill seems to have no philosophy to it. As a society, we should establish whether we have a policy of life at any cost.’

Sir Terry added: ‘I have seen people profess to fear that the existence of a formalised approach to assisted dying could lead to it somehow becoming part of national health policy..

He’s taking about the UK, but his point is valid. And the Nazi comparisons form the Republican party are defeating any possible rational rebuttal to even things like what Pratchett has to say.

Adam @#17
“Wouldn’t most people who get insurance through their employers be concerned if their employers started giving them advice regarding their health care?” Many employers do give health care advice and they do it to decrease costs. \

Part of my current job as a nurse, is talking with insurance companies to get admissions authorized. The system is seriously broken. Most people who have insurance, believe they have good insurance until they have to use it for a serious problem. Yes, the government is wasteful, but I’m tired of seeing insurance CEOs buying expensive toys like yachts while I have to argue over nickles and dimes for the patients.

By “random people” I simply meant that these are neither political operatives employed by Fox News (as some think, no doubt) nor brainless automatons incapable of thinking for themselves. As far as I can tell they are ordinary people expressing their views. And, yes, when they are under the impression that the people making all of the decisions don’t care about their views, I’m sure they will feel tempted to express their views loudly and angrily.

Adam@17 “When the stated purpose of this legislation is to curtail healthcare costs, and the entity that is responsible for these costs offers advice to patients regarding their healthcare decisions, isn’t it reasonable to think that this advice will be geared towards cutting costs?”

Well, see, here’s where you went wrong: the entity responsible for these costs would not be the entity offering the advice. The proposal is for medical insurance to cover a certain amount of time spent by a medical provider providing information about advanced directives, living wills, etc if the patient asks for that information. The most pro-active version I know about simply encourages providers to offer such information … which the best of them already do.

Because, speaking as someone whose family has made very difficult but good use of such things, such information is really really good to have.

I think it’s naive to believe that the government will be a completely impartial observer when it comes to giving people advice about health care or health insurance.”

Right now large corporations are in that role. How naive is it to think that’s a good idea, when their profits/bonuses/etc are directly linked to how much health care they don’t pay for?

About the bagels: quality varies with the place they’re made. To make an informed opnion, you should maybe mention where you got your bagels. To get the most authentic, you need to buy then in the right shop. Usually in or near the Outremont district of Montreal.
Of course, if you got your bagels from the Tim Horton’s shop on the ground floor of the Palais des Congrès, then you’d better try again at a real bagel place.

@Joyce I agree that serious reform is needed, I only disagree with the current administration about the nature of said reform.

@Jasper I agree that there probably are panels that sit around in any country euthanizing people. That’s the part of the discussion that has gone awry, in my opinion. And, of course, end of life care is an important part of health care. I don’t think anyone disputes that. But as the government has taken on the job of controlling the cost of health care, I think it’s reasonable to question their methods.

Adam – they’re probably not all brainless automatons, but the dolt who said “Get your government hands off my medicare!” ? Brainless. Likewise the idiots with swastikas, and anyone who thinks Glen Beck is a source of real news.

Which sadly applies to a lot of those protesters, because Beck’s media apparatus is responsible for getting most of these people out there, and for the Nazi comparisons they keep making. (incidentally the “Bushitler” comparisons from the left pissed me off as well).

Well if that’s the case then, as far as I can tell, we’re having a discussion now prompted by the fact that people at these town hall meetings have been trying to stop any discussion. Really, I don’t think an ordinary person at a townhall meeting feels that he or she has the power to shut down a national discussion.

Adam@17: When the stated purpose of this legislation is to curtail healthcare costs, and the entity that is responsible for these costs offers advice to patients regarding their healthcare decisions, isn’t it reasonable to think that this advice will be geared towards cutting costs?

You realize that any profit earning institution (like, say, a private insurance company) has this exact pathology, right? I can understand this idea being a concern, but I can’t for the life of me understand how this makes it worse than private insurance, which very explicitly offers advice and makes decisions about health care and is geared towards cutting costs.

@David Well, I think I know how my government is supposed to work and how it actually does work. The ONLY thing that prevents people in congress from doing whatever they want is the threat of removal from office. In an ideal world where people can remain well informed, this works fine. In the actual world, where people are mostly uninformed thanks to a lazy media and legislation with page counts numbering in the thousands, I think it’s a bit harder for your ordinary person to be informed about much of anything.

They’re over-the-top for my tastes, but unless I missed it, at no time did they try to stop any discussion. (Though they did sometimes temporarily interrupt some political kabuki.) They were trying in their own clumsy ways to bring attention to important things that most Republicans and far too many Democrats were trying to ignore — arguably true things, not arguably batshit things.

Are the differences between Code Pink and the teabaggers/birthers/deathers really that hard to see?

I think this is the point in a political conversation where I feel obliged to point out that I’m neither a Democrat nor a Republican and generally consider politicians on either side to be completely a totally full of shit.

Yes, the panels are for Medicare because currently, counseling patients about end-of-life decisions is a nonreimbursible expense. If you’re a conscientious provider you’d somehow try to find the time to ask patients and families about their wishes. Unfortunately, too often it doesn’t get done and people end up with treatment they really didn’t want. I’ve been very specific with my family about what I do and don’t want done for me if I’m incapacitated and can’t express my wishes; and most people I know in healthcare professions have done the same.

@Richard Gadsden Sorry, to be more clear I should have said that they have no need to convince the other people who didn’t vote for them that they are now right about this specific proposal to reform health insurance.

and @45: I think this is the point in a political conversation where I feel obliged to point out that I’m neither a Democrat nor a Republican and generally consider politicians on either side to be completely a totally full of shit.

Oh, a pox-on-both-their-houses-both-sides-are-equally-wrong-only-I-can-see-objectively-curmudgeon. Never seen that before.

Adam wrote: “The ONLY thing that prevents people in congress from doing whatever they want is the threat of removal from office.”

Well, er, yes.

That’s pretty much the key aspect of a republic. In theory, if you do whatever the hell you want, regardless of what your =constituents= want, then you’ll probably be voted out of office.

Unfortunately, however, in reality, the current state of -our- republic is such that the big corporate funders and special interest groups that put a politician in office are the constituents whose concerns he represents. And since there’s a LOT of money being made by various corporations and special interest groups in the current health care system, politicians who benefit from their support don’t actually make my jaw drop with shock when they oppose health care reform.

Adam: “I think this is the point in a political conversation where I feel obliged to point out that I’m neither a Democrat nor a Republican and generally consider politicians on either side to be completely a totally full of shit.”

I used to feel that way until it was brought home to me in a really forceful way that (a) what felt like me being all cynically wise was just me being a lazy-assed poseur and (b) the more people who feel that way, the easier it is for the subset of politicians who are full of shit to get away with it.

I’m still neither a Dem nor a Repub, but I’ve been following things closely enough for long enough to form a pretty damn informed opinion about which side has the higher shit-ratio these days.

I’m an independent, too. But the Republican Party eventually drove me into voting for and supporting the Democratic Party because, yep, during the past 8 years, one side had clearly emerged as having the higher shit ratio. Also the higher lobotomy ratio.

@Bearpaw I’m certainly not suggesting that we shouldn’t try to be informed, only that it’s getting more and more difficult to be well informed. I also don’t claim to be especially wise. I have my beliefs and, as it happens, they line up with about 20% of the platform of both major parties.

@Laura Resnick I wouldn’t argue with any of that. I always try to remain skeptical of anything that gets said by either side. I would also note that I see a big difference between skepticism and cynicism.

Adam@17 “When the stated purpose of this legislation is to curtail healthcare costs, and the entity that is responsible for these costs offers advice to patients regarding their healthcare decisions, isn’t it reasonable to think that this advice will be geared towards cutting costs?”
Not always. One of the things frustrating to me about politics is how people seem to always be dealing in absolutes. Certainly, when incentives (i.e. profit) are provided to health care advisors to cut costs, their advice might be intended to cut costs rather than save lives. But they also might be motivated by tons of other factors. A pop culture, dramatized example is the conflict between Dr. Cox and Dr. Kelso on Scrubs.
Certainly, some people might end up providing less than ideal health advice in the interest of making more money, but other people (like our friend Joyce above) would likely do the more humane thing and give good advice.
The death panel issue is thrown up in discussion as as something that cannot be overcome as a road block to shut down discussion, rather than as a concern to be addressed through well crafted legislation. If people are concerned that bad health care advice might be given, then put a guideline/law/regulation in place that counterbalanced the financial incentive and figure out how to enforce it. There will always be people who break the law, and the laws can always be refined, but a concern like the death panel is an issue to be addressed by this or a future legislation not something that makes it an impossibility.
Maybe I am the naive guy here, but not EVERYONE out there is a terrible person.

There’s a debate about healthcare? Not really. But there should be one. I was extremely disappointed to hear the president dismiss all other ideas and all opposition as nothing but lies.

I get nothing from insurance companies, and I have never listened to Glen Beck, but I find this proceeding far to fast. It is a very large and serious issue, and deserves some debate. There should absolutely be no pressure on congress to vote on a huge bill they haven’t even had a chance to read. I think that a nationalized health plan is coming, and is probably a good idea. But let’s be serious, and give the debate the time it needs.

Not everyone who is concerned about increasing government control over their lives is a raving maniac. There are legitimate concerns that need to be explained to people, rather than just casting their concerns aside. Many of us think that increasing the present medicare to cover more and more people until it is universal (but still optional) has a far better chance of succeeding and working.

I’ve asked my Representative to show me where the provision of medical services is listed as one of the enumerated powers of Congress under Article I Section 8. I’m sure my phone will ring any minute now. (I’m still waiting for a response on the same question regarding automobile manufacturing and financial instrument underwriting; I suspect it’s just that Rep. McCollum’s staff is really, really busy.)

Ordinary people expressing their views don’t scream their views at the top of their lungs until they get their way.

That behavior is usually left for defining a child throwing what most call a “tantrum”.

If they want their argument to be looked at as a serious issue, perhaps they should stop having their message delivered by people whose behavior when delivering said message comes off like paranoid, ignorant, hysteric imbeciles.

Just saying. If you want to sell your house, you don’t find the guy in the neighborhood wearing a tinfoil hat and mumbling about mind control to meet potential buyers and give them a tour.

I’ve asked my Representative to show me where the provision of medical services is listed as one of the enumerated powers of Congress under Article I Section 8.

When they call, could you ask them about retirement money, workplace regulations, minimum wage, health and safety issues, flight rules, communications regulations, highways, and…well, I have about three hundred others, but those will do for a start.

Brandon, my occupation requires me to attend a lot of City Council and County Board meetings, and I gotta tell you: ordinary people expressing their views quite often scream at the top of their lungs. Street assessments, zoning changes, recreation fees, library hours, fire equipment — all of it causes people to lose their shit. Hell, a co-worker of mine serves on an economic development authority, and they just got a restraining order put on one of their local residents!

Just because MSNBC doesn’t put cameras in these meetings doesn’t mean it doesn’t happen every month, in every jurisdiction in the country.

Now, let’s discuss the crowds in matching shirts with matching pre-printed signs and well-rehearsed chants about how the loud disorganized mobs are all just paid astroturfers…

I’m left wondering these days how long it’s going to take for the classic “smaller government, less government spending, state’s rights” part of the Republican party to split off into its own new party, just so they can get rid of the Jingo Jesus crowd.

@ slowdown – was extremely disappointed to hear the president dismiss all other ideas and all opposition as nothing but lies.

Do you get some special TV program where he says that? I’ve been watching him say he’d be happy to have a real debate, but that BS like “death panels” and pictures of him as Hitler are getting in the way.

Many of us think that increasing the present medicare to cover more and more people until it is universal (but still optional) has a far better chance of succeeding and working.

Then an elected representative can put it up as an option and they can all vote on it. That’s how a republic works. Not by screaming and throwing tantrums.

An Originalist response to your insinuation, I imagine, would be that retirement money is indeed none of the govt’s legitimate business (‘social security’s a scam, et al’). The next three things could quite conceivably be left up to the states, while the last three would probably fall under the federal govt.’s purview via the Commerce Clause.

Actually, the Originalist response would be that NONE of this is the federal government’s legitimate business. The main purpose of the Commerce Clause was to keep the “Several States” from charging tariffs from out-of-state goods transported either across their state, or into their state for sale.

The 9th and 10th Amendments (two of the most ignored amendments in the Constitution) make it clear that virtually all of the seven issues you list were either state or local issues, not those under the purview of the federal government.

John Marshall in Gibbons v Ogden (1824) ruled that navigation of ships fell under the federal mandate, so draw what conclusions you will about interstate airline travel. But the expansive interpretation of the Commerce Clause didn’t occur until 1937, when the Supreme Court opened the door to our current disaster of a system that got the federal camel’s nose in every single tent.

@adam – it’s actually easier to stay informed now, not harder. All one has to do is put forth some small effort. For example, I have close to 200 news sources feeding into Google Reader. I don’t read them all.. I skim. I promote the ones that consistently say interesting things. Apropos to this debate, here are two interesting articles:

The second article makes a key point I think – that we’re focused on who pays and on cost while ignoring the more fundamental issue of what we want out of the healthcare system regardless of cost or payer. The first shows pretty well that we pay about twice what other developed countries do and out health outcomes are below average.

Other fundamental questions – why does providing health insurance need to deliver a profit? I’ll try to dig up a citation for this, but I recall that the current crop of insurance companies collectively made a $450b profit in 2007… that’s a lot of money.

Before anyone screams “free market!!!” consider that the free market is a way to allocate economic resources… it’s not the sole way to accomplish everything. Note, also, that the data above indicates that the free market is doing a poor job of providing healthcare efficiently. That is, of course, because we incent short term goals (quarterly profits).

As a society, we could easily decide that a top level goal of a well-run society is to provide healthcare for every citizen. We then need to decide what ‘provide healthcare’ means and how we’ll structure a system to be cost-efficient. Given that virtually every developed (OECD) nation with a government run system has better outcomes for less cost, we might want to look at what they’re doing versus screaming about constitutional amendment, death panels and Hitler.

An Originalist response to your insinuation, I imagine, would be that retirement money is indeed none of the govt’s legitimate business

Yes, I imagine it would be. I also imagine that originalists somehow think that they’d be one of the independent yeoman farmers of 1789, rather than a whore, a slave, or a child who died of some horrible disease in infancy. It’s a similar idiocy.

Rick, I’ve got news for you. Health insurance is a product like any other. No one has a “right” to health insurance. No one has a “right” to demand that someone give their time and effort against their will. Last I checked, that was called slavery.

The free market isn’t the only way to provide services. There are all kinds of ways to do it. It’s just that it’s the only way that’s MORAL. No theft. Freely trading value for value.

“As a society, we could easily decide that a top level goal of a well-run society is to provide healthcare for every citizen.”

And who makes that decision? The person who needs the medical care — or the government? You want the government to have the power of decision in cases like this? You trust politics to never enter into the picture?

Remember the definition of government? Government=Gun. That was Mao, and he knew a little about forcing people to do things, didn’t he?

Think about decisions about your health made by those you oppose politically. Do you trust them to take care of you? Do they know what’s better for you than you do?

@rick I would argue that life expentancy is a poor way to measure the effectiveness of a health care system given that many things can affect this that have nothing to do with health care. As the article below shows, once accidental deaths are removed from the equation, life expentancy in the U.S. is actually better than life expentancy in other developed countries.

“Or, alternately, it was called “the draft” and it has helped the United States win one civil war, two world wars, and a variety of smaller ones. As I said, a similar idiocy.”

The Civil War allowed those with money to buy substitutes.
Both WW’s had so many volunteers that they had to take them into the armed forces in stages because they couldn’t accommodate them all at once. Drafting citizens to fight is just plain wrong.

Any country that is in peril that cannot get its citizens to volunteer to fight is doomed. Either that, or the peril isn’t perceived as real, and the citizens are being used as pawns.

Tell that to the doctors who will be forced by the government to change the way they treat patients.

Eventually, those coming out of med schools will have to have their career plans okayed by some board to keep certain specialties from having too many practitioners.

Tell that to the patients who won’t get the governmental okay for treatment because they’re too old and spending the public money isn’t “practical” or whatever buzz-word they’ll be using a la Dr. Ezekiel Emanuel.

They’re trying to sell a health care plan that hasn’t even been put into a final form. They’re trying to ram it through before people can get a real good look at it and break down what it really says.

It’s a con job, and a serious run at taking control of people’s lives by being able to turn off the health care spigot at will. Wake up.

Dave @ 82: “I also imagine that originalists somehow think that they’d be one of the independent yeoman farmers of 1789, rather than a whore, a slave, or a child who died of some horrible disease in infancy. It’s a similar idiocy.”

I’m not entirely sure how prostitution and infant mortality fit into theories of constitutional interpretation (unless you’re arguing for a federal law against prostitution, or suggesting that medical science has progressed past 18th century standards thanks to the federal govt.). As for slavery, I might point out that it was ended (officially, at least) by the one mechanism to which Originalists have absolutely no objection: that is, amending of the Constitution.

The Civil War allowed those with money to buy substitutes.
Both WW’s had so many volunteers that they had to take them into the armed forces in stages because they couldn’t accommodate them all at once. Drafting citizens to fight is just plain wrong

The Civil War: And?
World Wars: No, they didn’t.

Any country that is in peril that cannot get its citizens to volunteer to fight is doomed

Then just about every major country since the mid-19th century has been doomed for a long time. Taking them a while to actually manage the “doomed” part, isn’t it? The United States has been doomed for longer than it hasn’t been doomed.

I would like to find some information regarding the Dutch euthanasia practices. I’ve read that the elderly and chronically ill often avoid getting adequate medical help because they are afraid of their doctors unilaterally opting for euthanasia. If someone has info, I’d appreciate it, because I think it’s that kind of fear – the authorities are going to kill me – that drives the death panel discussion. It’s magnified, really.

I’m trying to find how the government is going to pay for this – Obama says he expects it to be to revenue-neutral, but nobody believes it, especially after the CBO’s reports of the partial costs being $1 trillion dollars.

I wrote both George Voinovich and Sherrod Brown (Ohio’s senators) and asked 2 questions: have you read the bill and how do you plan to pay for it. Voinovich hasn’t answered (by email, but I think he usually responded via snail mail in the past) and Sherrod Brown blathered on about his feelings and didn’t answer either question in his email. Is it too much to ask?

Dave in Georgia–I understand your concerns about funding for health care, and they’re valid. It’s big, and potentially scary, and there are a lot of moving parts. But for me the issue comes down to this: according to a 2004 study by the Institute of Medicine, 18,000 Americans *die* due to lack of health insurance every single year: http://psychservices.psychiatryonline.org/cgi/content/full/55/2/203

And that’s not counting those like Natalie Sarkaysian, whose family actually *had* health insurance… but whose insurance company, Cigna, refused to pay for a liver transplant, under the grounds that a liver transplant was an “experimental procedure.” Natalie’s parents couldn’t afford the procedure without Cigna covering it; UCLA was unable to perform the transplant without authorization from Cigna; and so, Ms. Sarkaysian died.http://cbs2.com/local/nataline.sarkisyan.CIGNA.2.615167.html

We’re talking about *preventable* deaths here, Americans who would still be alive if we had a better system. Insurance company executives make decisions that are quite literally killing us.

When you say “No one has a “right” to health insurance,” what that translates to in the real world is “rich people get the care they need to get better, poor people don’t, and most middle class people don’t.”

It is *profitable* for insurance companies to deny treatment to sick people; it is profitable for them to deny treatment to people they were supposed to cover. So that’s what they do. And most of the people on Medicare are fine with the government deciding what’s covered by Medicare and what isn’t. (Can you point to someone who used to have Medicare who has voluntarily given it up for private insurance?) You’re worried about government people making decisions about what kind of care you get? What we have now is a world in which *health insurance industry executives,* concerned only with profit, decide what care you get. Or not. Given how Ms. Sarkaysian ended up (whose family, I remind you, had insurance), I think I’ll take my chances with the government. And something tells me the 18,000 families of the dead from this past year would’ve rather had that option as well.

The Civil War allowed those with money to buy substitutes.
Both WW’s had so many volunteers that they had to take them into the armed forces in stages because they couldn’t accommodate them all at once. Drafting citizens to fight is just plain wrong.
Any country that is in peril that cannot get its citizens to volunteer to fight is doomed. Either that, or the peril isn’t perceived as real, and the citizens are being used as pawns.

I’m going to take another crack at this, because the level of sheer stupidity requires more discussion.

1. The Civil War–so you’re holding up the fact that rich people could pay their way out of the draft as a *good* thing? You somehow think that putting the fight on the poor and middle-class was actually a beneficial feature?

2. A lot of WWII volunteers were those who went and joined the Navy and Air Force because they didn’t want to get drafted into the PBI (poor bloody infantry). Perfectly rational but not the heroic members of the polis that you seem to be imagining.

As to “Any country that is in peril that cannot get its citizens to volunteer to fight is doomed,” every society since the dawn of time has used some sort of compulsion to get its people to fight. What, you think that Greek farmers had a choice of whether they were members of the phalanx? Oh, hell, no.

Your version of the past has about as much to do with actual history as intelligent design has with real science.

I’m holding up the Civil War as hypocrisy. The folks at the top could buy their way out. It works that way in every draft — them as has, gits — as the old saying goes.

And as for those that joined the Navy and Air Force, they got chewed up in both theaters as the PBI (luckily my old man made it out of the Ardennes, or we wouldn’t be having this discussion).

As for Civil War volunteers, the South didn’t have much trouble filling its ranks. It was the North that did, and that led to the Draft Riots in NYC.

As for the denial of the avalanche of volunteers for both WW’s, you’re wrong. The US Armed Services weren’t ready for the influx in 1916 or so, or after Pearl Harbor. It took nearly a year for all those that volunteered to wind up at Basic. In WWI, they had to use wooden rifles for drill until they got enough weapons to hand out to everyone.

I’m not going to say how great the insurance companies are. But I will say that with insurance companies you at least have a choice.

When the government gets involved as the decider, you have no choices. All the countries with socialized medicine are having huge problems. The NHS in Britain is bragging about only having a 7-week wait for elective surgeries.

That’s something to brag about?

Canada is falling apart as well. They have the safety valve of having people able to escape to the U.S. for treatment.

For instance, Natasha Richardson might very well have survived her skiing accident if it had happened in Vermont rather than in Quebec, since she would have been choppered out to a major trauma center a whole lot sooner if it had happened in the States.

Dave in Georgia @ 95:
Not that I’m unsympathetic to your position regarding the draft (and I’m from Ga too, incidentally), but the South actually introduced conscription nearly a year before the North did.

I’m sorry to point this out, but you’re definitely wrong about the draft during WWII. The Selective Training and Service Act (aka the Burke-Wadsworth Act) was passed in 1940 (in peacetime, of course); the term of service was extended in the summer of 1941 (still in peacetime–the original draftees were seriously angry over being told they weren’t going to get out of the army in 12 months), and once the war began, conscription continued until it ended.

I’m not quite sure what this has to do with health insurance/health care, or your other points, but there it is.

Oops–sorry–the previous comment was to Dave in Georgia @ 95. By the way–reviewing your comment, Dave in Georgia–you are quite right that there was a flood of volunteers after December 7, 1941. However, men between the ages of (I believe) 18 and 45 still had to register for the draft and continued to be drafted in considerable numbers throughout the war.

The protesters at the town hall meetings took a page right out of the far left whack jobs who wailed and screamed at Bush. I find it all very funny that now exercising ones right to protest is now un-american.

Waiting time for elective surgeries in the US are often two to seven times as long as the seven weeks you claim are long for other countries. This is for insured people.

And I think you need to cite your sources; very few in Canada would agree with your statements (and would think them rather insulting). For example, state of Washington doesn’t see that many inflow from Vancouver for standard medical procedures. They WILL for advanced cancer treatment, but that’s for the world class treatment centers in Fred Hutchison and the Cancer Care Alliance—but that’s sort of the point for advanced treatments.

I would like to find some information regarding the Dutch euthanasia practices. I’ve read that the elderly and chronically ill often avoid getting adequate medical help because they are afraid of their doctors unilaterally opting for euthanasia. If someone has info, I’d appreciate it, because I think it’s that kind of fear – the authorities are going to kill me – that drives the death panel discussion. It’s magnified, really.

Were you looking for N Engl J Med. 2007 May 10;356(19):1957-65?

The abstract reads BACKGROUND: In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices. METHODS: We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%. RESULTS: In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used. CONCLUSIONS: The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation. Copyright 2007 Massachusetts Medical Society.

It sounds like someone construed the increased use of sedatives (for pain relief) as “doctors killing patients”, which I’m not sure is accurate.

Speaking for a moment as a peer-reviewed mathematical Biologist who taught a High School course that was much about Evolution by Natural Selection — and 1/3 of the students were from Creationist/Intelligent Design families, and I was insulted by some yahoo parents: “Teach the debate” is a Machiavellian slogan invented by intentionally fraudulent demogogues. There is NO debate about Evolution by Natural Selection — except the one that they initiated, amplified with astroturf, and lost in court. Sound familiar? The “Health Care Debate” — about such crud as “Death Panels” is no more a debate than the “debate” about whether or not there were T-Rexes in the Garden of Eden, and why if they were vegetarians, did they have such big fangs?

When the government gets involved as the decider, you have no choices. All the countries with socialized medicine are having huge problems.

By the way…from the studies I’ve seen (for example, from the Kaiser Family Foundation , health care costs in other countries are going up at lower rates than the US. Since these other countries cover more people for lower costs per capita than the US and get better results, I think it’s a rational choice to take those “huge problems” rather than the US’s “huge problems.”

Dave in GA – Frankly a seven week wait for surgery would sound like heaven on earth to a whole bunch of people I know. Like my mother-in-law, who died two years ago for lack of a simple surgery, because my in-laws could only afford to cover one person. But they had a choice! They could have covered her instead, in which case my FIL would now be dead from prostate cancer.

I trust the government a whole heck of a lot more than I trust the CEO of BCBS, or Aetna, or any of the rest. They’re not as likely to take your payments happily for ten years only to decide to drop you when you actually develop an illness because your acne as a teenager (which has nothing to do with the MS you just developed) which they never objected to before, was actually a disqualifying condition. But they’ll keep the ten years of payments, thank you.

At least I can do something (like try to get different people elected, write to my representative, etc.) if the government veers into bad territory. My health insurance (employer provided, so not so much choice there, unless I want to quit in this economy), really doesn’t give a squat what I think. They just want to not pay back the money I paid in when they lose the bet they made about my future health.

As a Dutchman, I’d like to assure you that whatever you read and wherever you read it was complete and utter bullshit, most likely the old “Culture of DEATH AND INFANTICIDE” alarmist idiocy that the right wing in the US likes to shout out.

Yes, doctors are allowed to actively euthanize a patient at that patient’s request, if and only if several factors apply:

1) The patient is mentally capable of understanding what he or she is asking for at the time they’re requesting it, and has “soundly considered” it.
2) The patient’s condition is essentially untreatable and amounts to perpetual suffering;
3) The patient has been fully informed of their condition and his prospects;
4) The patient and doctor are agreed there is no reasonable alternative to the situation;
5) At least one independent doctor has been consulted and concurred on the record to all the above.

If the above all apply, AND the doctor has performed the euthanasia with ‘a medical degree of carefulness’ (poor translation, I don’t know the exact equivalent term), then the mandatory investigation panel will eventually, after considering all the documentation on all six steps, agree that he did what he had to do. The onus in that panel is somewhat equivalent (I’m guessing) to the way Internal Investigations has to investigate every single instance of a cop shooting someone.

Hope this clears up a few things – not that the GOP is going to let people confuse the issue with such trivialities as facts.

Slight addendum to previous: Getting those six points straight took all of thirty seconds googling “Nederland Euthanasie wetgeving” (Which is decadent socialist Dutchese for “Netherlands euthanasia laws”) and according to the wiki page that’s been the law as of 2001.

Evidently, whatever blog or news article Cassie read was too busy vomiting up scare stories to goad the gullible and the fearful to spend thirty seconds of their own trying make sure they were reporting the truth.

As someone in a modern country with semi-socialised healthcare (New Zealand), I think you guys are making a mountain out of a molehill. Overall, it seems to work remarkably well. It’s not perfect by any means, and most people who can reasonably afford it obtain health insurance as well, but I think you’d have to work pretty hard to find a decent number of people here who felt that removing it was a good idea.

The essential reason why I like it so much is how much it simplifies the issue of treatment. In the face of injury, the first thing almost anyone here does is go to a doctor or hospital. They won’t have to pay for this service, and depending on severity they will be seen reasonably quickly.

As a result, issues are seen (and sometimes treated) early, rather than people waiting until the issue demonstrates symptoms severe enough to justify investment or insurance complications. As almost any medical professional will tell you, early attention can often dramatically simplify treatment.

Health insurance and the free market are alive and well here, and I imagine they’d remain so even more in the US. It costs us, but it’s not an economy killer and honestly? I wouldn’t want to live in a country without it.

” In the face of injury, the first thing almost anyone here does is go to a doctor or hospital. They won’t have to pay for this service, and depending on severity they will be seen reasonably quickly.”

You forget we are talking about Americans, not the most rational folks. My cousin got shot about a month ago and actually called for my opinion about bothering to go to the doctor. Big noise, entry wounds and no exit wounds and he was not sure he should seek medical attention? BTW, he is also a birther. I like the family toughness but am wondering about the brains. (What is depressing is that he is from the “sane”side of the family. The other side would not have noticed the wound.)

Let’s skip the ad hominems, okay? Calling someone an asshole because they disagree with your basic premise is the same thing as shouting them down. It contributes nothing to the debate.

The main problem we have with healthcare costs is that those costs aren’t details and described up front. How much does it cost to have a tonsillectomy, and what’s the breakdown? We don’t know these things — we find out after the fact, and don’t worry about the minutiae because the insurance company pays.

There’s a disconnect between patient and payment, which means we’re not looking to save money. We’ve forgotten the golden rule here — He Who Has The Gold Makes The Rules. The person writing the checks and shelling out the cash calls the shots, every time.

Because of tax laws passed during the WWII era, health insurance became the near-sole province of employers and government. That put individuals at the mercy of others and set up this current mess.

What’s being proposed is more of the same, except there will be a greater disconnect. Why do we assume that the government, a single entity that allows no competitors, will be better than dealing with multiple insurance companies who have to compete with each other? This type of thing has been tried in a number of states over the past decade-plus, and every single program turned into a disaster and went belly-up — TennCare, MediCal, etc.

It’s the Tragedy of the Commons. The whole concept is flawed. Water will not flow uphill. TANSTAAFL.

Insurance companies suck. No argument there. They make money through not paying out for services. But handing it over to the government is an even worse solution. Letting a group make life-and-death medical decisions because they control the purse strings be the same entity with the power to force you do act against your will is suicidal.

Having one group make all the decisions for everyone is, on its face, bad. They make a mistake, everyone suffers. The obvious remedy to the problem is to diffuse the power to as many different entities as possible. Try different solutions. Why not Medical Savings Plans? Why not allow individuals and small groups to pool and get group insurance? Why not allow purchase of insurance across state lines? Let’s try ’em all at once, letting the individual states experiment as they wish. The best ideas will thrive, while the bad ones will be exposed.

The current federal proposal is hogwash. They’re trying to get a bill passed that hasn’t even been written yet. It’s long, confusing, and they’re doing a big ol’ tap dance to try to distract everyone while they ram something through.

That’s what the screaming is about. People don’t trust Congress. That’s just common sense.

Here’s a quote to illustrate why I trust insurance companies more than I trust the government:

“Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.”

Dave in Georgia @ 115 – Here’s the problem I have with your argument – you speak as if this is something that’s never been done.

Except all sorts of people, such as the gent from New Zealand, our Dutch friend, and my Canadian correspondents on LiveJournal, live in places where this has been done. Contrary to your statements, their system works, people are happy, and their countries spend signficantly less per capita then we do on health care.

In short, you are arguing a theory. Theories are only useful if they are predictive – if you can use them to determine what will happen. Since what you theorize will happen hasn’t in any “socialized medicine” country, your theory has no predictive value.

Dave, I hate to break it to you, but you’ve been talking about a scenario that won’t happen. Private insurance companies are still going to exist if Obama’s plan gets passed. They exist in Canada and the UK, as well as countries like Australia. Most Australians I know have private insurance. If they get laid off, they go on the public option.

It’s been amusing watching you spin fantasies of a totalitarian slave state where doctors are chained to gurneys and forced to kill grannies. But enough is enough. This isn’t a debate, because you’re not talking about anything to do with the actual bill, or current health care practices.

Hey, Adam, that’s nice for you. You stick with a private insurer then. This is why they call Obama’s plan a public health care option. Because you have the option of taking the public plan. Or you have the option of a public plan.

Without a public option, people who get seriously ill while uninsured frequently just die, and if they don’t, end up with crippling debts.

You, like Dave in Georgia, are talking as if that no one will have a choice if Obama’s plan is passed. You’re not debating, you’re prevaricating.

This bill is a Trojan Horse. Under Section 102, any change to the policy, including rate changes or changes in benefits, means that you can’t keep your plan. Not only that, if you’re a new hire, you can’t join the plan.

In other words, private insurance will be slowly phased out and the government plans will be the only options.

Part of the reason heath care costs are greater here is the fact that we’re the center for health care research. It has to be paid for by someone, and since other countries have set their prices by fiat, we get stuck for the entire bill. Of course, all those advanced cancer clinics mentioned earlier in the thread (add in M.D. Anderson in Houston) are in the U.S., not those other countries.

And people have to come here for treatments, which means they either have a lot of money, or they get charity help from Americans.

The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated;

Well, there’s youre problem right there. You only consider cruelty as a direct action, whips flogging, death panels, and such. You’ve not once in this thread acknowledged the severe cruelty that comes from indifference, from inaction.

The robber barons will throw you under the bus if you have a preexisting condition, if you’re exceed your lifetime maximum, or if you’re unemployed and can’t afford to pay the barons anything at all. When it no longer becomes profitable, they will cease to act, they will become indifferent to your troubles. And that is a real cruelty that is happening to real people now.

And here you are advocating in favor of this very real cruelty of indifference while condeming some hypothetical cruelty of direct action that might someday manifest itself as “those who torment us for our own good”. Real people are dying due to inaction, and you say we should continue inaction for fear of some cruel not-yet-existing boogeyman that might someday inhabit the space under our (hospital) bed.

You want to talk about cruelty? Then lets talk about the cruelty of indifference. The cruelty of someone who could help his fellow man but chooses not to.

Libertarianism taken to the extreme of sociopathy yields a man who cares nothing for his fellow man and who has convinced himself that his indifference to his fellow man is a kindness. He becomes cruel with the approval of his own conscience, asking the morally indifferent equivalent of: “Are there no prisons? Are there no workhouses?”

“If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population. Besides—excuse me—I don’t know that.”

“But you might know it,” observed the gentleman.

“It’s not my business,” Scrooge returned. “It’s enough for a man to understand his own business, and not to interfere with other people’s. Mine occupies me constantly. Good afternoon, gentlemen!”

Part of the reason heath care costs are greater here is the fact that we’re the center for health care research. It has to be paid for by someone, and since other countries have set their prices by fiat, we get stuck for the entire bill.

This is also wrong, though not in an obvious way. Research into health care is, in no way, connected to health care COSTS. Don’t conflate the two (it’s obvious to me, since I’m a fundraiser at a major university, so I know where money comes in for research into the various parts of medicine, which includes basic research, drug development, patient care and preventative health).

Moreover, the various private entities where money goes to for drug development and treatment development are multinational in scope. THe US is not THE center for health care research, it is A center…and in many areas, not a leading center. And, of course, those countries who do lead in those areas (and are competing with the US in other areas) are socialist.

Insurance companies suck. No argument there. They make money through not paying out for services. But handing it over to the government is an even worse solution. Letting a group make life-and-death medical decisions because they control the purse strings be the same entity with the power to force you do act against your will is suicidal.

Are you paying attention? This bill does not hand over purse strings over to the government; at most, it creates a public option AND KEEPS THE PRIVATE OPTION OPEN. And, again, in other countries where the government DOES hold the purse strings, indviduals live longer, pay less and have better coverage. That does not sound like suicide to me.

YOur rhetoric does not seem applicable because it has no relation to reality.

When the government gets involved as the decider, you have no choices.

But if your insurer decides, how do you have more choice? Why do you prefer to have the decision made by a corporation which is explicitly goaled on returning value to its stockholders, rather than on keeping you healthy?

All the countries with socialized medicine are having huge problems

Providing medical care in society is a huge problem. There are better and worse ways of going about it.

The NHS in Britain is bragging about only having a 7-week wait for elective surgeries.

That’s something to brag about?

Why yes, it is. “Elective” means “not urgent”. Seven weeks is a quicker lead time than I can get a builder to refit my bathroom; for surgery (that I will not have to pay anything extra for) I think that sounds pretty good.

Some of the ideas underpinning your position might benefit from further consideration.

Dave@106 – the tangent about the draft:

“Got my facts wrong on the draft. I bow to those who disagreed with me on the draft
…
And quite frankly, the history of the draft only reinforces my position on this one.”

That sounds to me like “it turns out the facts I based my point on are actually the opposite of what I thought*. Nevertheless they still prove my point”. Which just makes me go “bwuh?!”, especially since you don’t seem to be arguing in bad faith.

Passing over this obscures a valid debate about what legitimate demands your society can make of your time and effort (though admittedly that’s somewhat off topic here).

*which seems to be that to demand that someone give their time and effort against their will…is called slavery.

This link shifts the goalposts, from discussing the NHS to discussing the medical systems of Greece, Turkey, Egypt and Libya. Perhaps I was wrong in assuming you are arguing in good faith.

Just a couple of quick points about that article:

Greece is not a socialist country;it is parliamentary republic.
Turkey is not a socialist country; it is a republican parliamentary democracy.
Egypt is not a socialist country; it is a republic (arguably an authoritarian state).
Libya. Congratulations! Libya considers itself a socialist country (in practice, it is an authoritarian state).

None of the above are considered in Europe to provide good health care, and I’m pretty sure nobody is advocating following their models.

If you want to find examples of state-run healthcare done poorly, I don’t think you’ll have much difficulty. Your challenge – if you want to use foreign systems to make an argument why the U.S. should not move in the direction of socialised medicine – is to point up how the state-run healthcare systems that are generally considered to be successful are inferior to the current U.S. system, or to point out how a similar system could not work in U.S.

Everyone seems to be talking about who pays, single payer vs. public option vs. free market, but no one is talking about how we might fundamentally change the system. Do we try to involve health care providers earlier in the process preventatively? Do we try to drastically reorganize our healthcare system so doctors visit homes rather than sick people visiting emergency rooms? Do we mandate that every person is covered, why or why not? Do we need to change the farm bill to stop artificially decreasing the cost of unhealthy food and hurting the long term health of the poulace? What are we doing right and what wrong from a health perspective? Etcetera ad naseum.

How we pay seems to be the first question here when it should be only one among many. Most of the discussion on this topic seems to be too limited in my view.

Jester, a lot of that is what Obama *is* talking about – more preventative medicine, better diets, etc…

It’s sort of hard to hear it through all the “death panel” and “socialism”? Isn’t it. Almost as if some group of people were trying to drown out a reasonable conversation.

There’s a lot of good ideas out there. I think that, while Obama’s plan isn’t perfect, it’s not going to forcibly euthanize anyone’s grandma and it’s at least a good start.

Obama is trying to do two things – slow the rate at which health care costs are growing, and widen coverage, because the uninsured are a hug drain on the economy, and are part of the reason costs are increasing. From what I can tell, he, and the Democrats on his side, are open to reasoned debate. It’s just that they’re getting drowned out by noise.

And, speaking as a cynic, they’re overplaying the noise to score political points. But it’s not like it requires much overplaying, I’m sorry to say. Most of the opposition is repeating some of the most absurd claims there are.

If Obama and the rest of the Democrats really wanted a conversation (and I think they started out wanting one, but got side tracked by the red meat of the insanity of the Republican talking points) they could *ask* for one that. Another “beer summit” or something. Any sign of diplomacy would help at this point. But who would they ask? That’s a part of the problem. I can’t think of anyone on the Republican side who’s being reasonable. It might be because the media is ignoring anyone reasonable on the Republican side.

There’s some bad faith on the side of the Dems. It’s just that there’s a whole huge heaping mound of it on the GOP’s side.

The problem with the so-called “public” option is that the government is not on a level playing field with private firms. There is no necessity to make a profit. They can undercut the private sector (look at anyone trying to get a mortgage!) and they have the literal power of the purse, i.e. the ability to create fiat money and charge those who aren’t using the service to pay for it.

Obama and others arguing for the plan have made public statements that they see single-payer (socialized) as the inevitable final goal once there is some sort of public option to be had. Why should businesses pay for health insurance if the government will do it. That will dry up the private health insurance business by stealth.

AND @132

Sure, they’re multinationals. But the only place left where they can recoup their research costs is the good ol’ U.S. of A. And when that won’t happen anymore, why bother doing the research? It just turns into a money pit with no chance of recompense. Nobody works for free — nor should they be expected to do so.

@131 Russ

You can sue insurers. But you can’t sue the government. Says so, right there in the laws they make themselves.

As for the draft thing, (and yes it is off topic), the 1940 law that created the first peacetime draft in U.S. history had the government moving the goalposts right when the first draftees were set to head out the door as the law had previously stated. Governments are famous for moving goalposts when it suits ’em. How do you fight a government for doing that? They’re the final arbiter.

@Josh Jasper The problem with that logic is that most people get their health insurance through their employer. I have no control over the plans my employer chooses to offer. So Obama’s statement that we can keep our current plans if we like them is not completly accurate. He knows, as well as I do, that my employer may choose to ditch our current plan in favor of a cheaper “public option” if he can. Then I lose my insurance plan (which I’m pretty happy with, thanks). All the government has to do is price their plan lower than any other and soon any employer that is able to will be dumping their current plans. The “public option” can also benefit from government subsidies unlike other private insurance companies.

Dave in Georgia@136: Japan has had private health plans through employers coexisting with public health plans for the self-employed or unemployed for many decades. For some reason, your fears have not been realized in that country. How do you explain this?

David @ 94: 2. A lot of WWII volunteers were those who went and joined the Navy and Air Force because they didn’t want to get drafted into the PBI (poor bloody infantry). Perfectly rational but not the heroic members of the polis that you seem to be imagining.

Pedantic quibble: The Air Force did not exist as a separate service in WWII. It was still part of the Army. I don’t know if you could pick what part of the Army you volunteered for.

Australia has much the same system as well. Public and private plans coexisting. They spend less than Americans do on health care, get better care, and everyone is covered. If you work at McDonalds, you probably have public care (which, BTW, is better than my really good private insurance in the USA) but if you work at a white collar job, you probably have private insurance.

Beyond that, there’s this crazy liberal notion called “collective bargaining” and “unions”. For some reason conservatives believe that, if an employer changes a health plan for the worse, all of the employees have to shut up and accept it. For all the Conservative talk about a love of freedom and liberty, they’re cowards when it comes to using it in the workplace, but “brave” at defending an employers right to screw with his employees.

What’s sad is how many workers get caught up in the nonsensical idea that the bosses having all the power in the relationship, and workers having none is the way things have to be, morally speaking.

The problem with the so-called “public” option is that the government is not on a level playing field with private firms. There is no necessity to make a profit. They can undercut the private sector (look at anyone trying to get a mortgage!) and they have the literal power of the purse, i.e. the ability to create fiat money and charge those who aren’t using the service to pay for it.

Sure, you develop a plan where the public option sucks all the patients away from private insurers. You can also develop a plan where the public option can’t compete at all, even with uninsurables. But are you saying the US is too stupid to develop a plan that’s better than these two extremes? When other countries in the world have been able to do so?

Sure, they’re multinationals. But the only place left where they can recoup their research costs is the good ol’ U.S. of A.

Dave in Georgia @ 136 – You still didn’t answer my question, which in fairness may have been unclear. Why should America have to subsidize the rest of the world’s R & D costs? Is Great Britian, for instance, when (if) it suddenly sees pharma companies not investing in R & D, going to throw up its collective hands and say “oh, well, I guess we’ll just die?”

Regarding your “moving the goalposts” remark – as I recall, there was an election in 1942. If people were unhappy with the draft, they could have elected people to stop it. That’s kind of how democracies work.

Adam @ 137 – One of the factors driving insurance decisions in many companies (including my own) is that the owners put themselves on the same plan as the employees, because it’s cheaper. So for a lot of companies, dumping the employees to a crappy public system means dumping the owners too.

Also, I’m a tad curious about how much of the research costs are strictly R&D related and how much are somewhat dubious…For example, marketing is a component in drug development costs—that’s US only, as many countries don’t allow marketing/advertising direct to consumers (only to doctors). Thus it wouldn’t be quite fair to include that in costs that companies would have to be allowed to recover. Human trials, yes….but is marketing or conducting clinical trials not for the purpose of seeking FDA approval but simply to gather data to persuade doctors to prescribe a particular brand of medication a fair thing to include in development costs?

As for the draft thing, (and yes it is off topic), the 1940 law that created the first peacetime draft in U.S. history had the government moving the goalposts right when the first draftees were set to head out the door as the law had previously stated. Governments are famous for moving goalposts when it suits ‘em. How do you fight a government for doing that? They’re the final arbiter.
Quis Custodiet Ipsos Custodes?

You’ve heard of these things called “elections,” right? The American people had a chance in 1942 (Congressional) and 1944 (Presidential and Congressional) to vote out the offending members of government. And, in fact, in 1942, the Democratic Party majority in the House slipped substantially, forcing Roosevelt to bring more Republicans into the Cabinet. In 1944, FDR won a fourth term in an electoral landslide, 432 electoral votes to 99.

This is how a democratic republic works and it’s a bit worrying that you’re seemingly not aware of it.

Pedantic quibble: The Air Force did not exist as a separate service in WWII. It was still part of the Army. I don’t know if you could pick what part of the Army you volunteered for.

Chris Gerrib @142 – “One of the factors driving insurance decisions in many companies (including my own) is that the owners put themselves on the same plan as the employees, because it’s cheaper. So for a lot of companies, dumping the employees to a crappy public system means dumping the owners too.”

I may be wrong, but I think employers have some pretty serious limits on offering different plans to different employees. It isn’t that easy to do that. I believe it is similar to how they restrict 401K contributions among “highly compensated” employees to a limit established mathematically based on the average contributions of less compensated employees. Can anyone confirm?

If I were going to reform our health care system, the first thing I would do is remove the employer from the equation. The only reason employers are involved now is because health insurance purchased through your employer is tax free whereas privately purchased insurance is not. Think about it: the insurance companies work for whoever pays them. Right now, most people pay about 30% of the cost of their health insurance, with the government and the employers making up that other 70%. So who do the insurance companies work for? Not the individual. You fix this by forcing people to pay the full cost of their health insurance. Anytime you introduce an arbitrary layer between the producers of a service and the consumers, you can always expect higher costs and more inefficiency.

By the numbers, there is nothing stopping the Democrats from passing any damn healthcare law they choose. They have filibuster- and veto-proof numbers in both houses of Congress, and a president who won’t veto a healthcare reform bill, period. If the Obama health care plan is so gosh-danged good, why not just vote for it already? Pass it and let everyone see exactly how great it is in action for the majority of citizens.

But they don’t. What does that tell you about the confidence Congress has in the obvious benefit of the health reform act in front of them?

The only reasons for a “debate” are to convince people that a bad plan is, or can be made to be, good — and to do so without suffering any political backlash which might turn current elected Democrats out of office.

This debate isn’t about healthcare, it’s about seeking enouh political cover to pass the buck when/if it becomes an unsupportable money-sucking debacle.

Dave in Georgia: You sound concerned about this but, in all seriousness somebody on your side of the debate has to explain in clear, rational language why the US is incapable of doing something that every single other major industrial nation manages.

It’s that simple really. The UK has it’s faults, I’ve lived with the NHS most of my life, but so does the US system. And, of the two, the UK seems much better.

Sorry I don’t buy this tax code argument about “insurance”. To start with – it’s not insurance.

I have hypertension, my wife has asthma and some other conditions that need a fair amount of medication (about $300ish a quarter or so, mine is only $30).

However, how on Earth can we get insurance for things that we have? Changing the tax code and making insurance personal more portable doesn’t work unless you also put in provisions for forcing private companies to insure people who are already ill and, frankly, there isn’t a sound business reason for them to do that.

The UK system is much cleaner. Everybody gets a minimum level of service guaranteed. It looks after the strep throats, the broken bones, the emergency apendectomies, the child births and so on. But if you want to, and can afford it you can also take out _insurance_ against the serious stuff that lets you see specialists faster and get elective surgery quicker.

There are no death panels, there’s virtually no difference in life expectancy (being honest about it) and, here’s the kicker, the British are spending about 40% of the money on Healthcare that Americans are.

They have filibuster- and veto-proof numbers in both houses of Congress, and a president who won’t veto a healthcare reform bill, period. If the Obama health care plan is so gosh-danged good, why not just vote for it already? Pass it and let everyone see exactly how great it is in action for the majority of citizens.
But they don’t. What does that tell you about the confidence Congress has in the obvious benefit of the health reform act in front of them?

They don’t have a veto-proof majority in the Senate. That would be 67 votes. On your larger point: bull. Acting like the Democrats (or the Republicans) are some monolithic entity is just silly, and there’s all sorts of constituencies at play here. Arguing that it’s some sort of conspiracy to make the eventual bill look good is either ignorant or mendacious.

Adam@137: He knows, as well as I do, that my employer may choose to ditch our current plan in favor of a cheaper “public option” if he can. Then I lose my insurance plan

Oh. My. God. I’m always amazed at how perfect a system this “invisible hand” of the market can produce, but how fucking fragile it is that it can’t handle anything that isn’t laissez faire.

No public option, and you’re invisible hand gives you perfect medical insurance. Government adds a public option intended for the uninsured, and your invisible hand collapses into nonsense.

This system of the invisible hand is either one of the most sensitive (but yet perfect) systems for captalism, OR, its a bunch of propanganda crap that laisezz-faire libertarian capitalists spew anytime someone tries to put any limit whatsoever on the market.

Since the only laisezz fair/libertarian utopias that I know of in the real world are places like fricken Somalia, I’m far more inclined to believe that this invisible hand thing is a bunch of propaganda.

Adam@150: Apparently, disrupting a townhall meeting is great if you’re going it for the “right” reason

Yeah, if you think you’re comparing apples to apples, you’re insane.

The “death panels” is a bullshit concept started by insurance company hacks and propagated by right wing nuts who are only interested in obstructing any kind of progress. It’s industrial grade bullshit.

People protesting the Iraq war weren’t funded by corporate shills, weren’t told by media hacks to go out and disrupt town meetings. And most importantly, didn’t base their disruptions on lies and bullshit.

If anyone was lying about the Iraq war, it was the assholes who told us they were certain that Iraq had WMD’s and were certain that Iraq was connected with 9/11.

So, your comparison is entirely backwards. Only in the mind of someone totally insane would those two events have any equivalence of any kind.

Dude, seriously, you’re why people roll their eyes when I say was born and bred in the state of Georgia…cut it out.

Because of tax laws passed during the WWII era, health insurance became the near-sole province of employers and government. That put individuals at the mercy of others and set up this current mess.

What? Try again.

You act like health insurance had been around for centuries before that. It wasn’t. “Health Insurance” as a product was only around for about 20 years before a *wage* freeze during WWII caused employers to beef up their health care offerings in lieu of increased pay — wages, not *taxes*. The tax part made your insurance tax deductible.

Condensed history of medical history in the US.

1929 – teachers in Dallas, Texas, contract with Baylor Hospital for room, board, and medical services in exchange for a monthly fee.

1930-1940 – *private* companies entered the field as the popularity of health insurance increased.

1940-1950 – Unions bargain for better benefit packages, including tax-free, employer-sponsored health insurance, and companies and plans proliferate. (So yes, the private insurers conservatives are so afeared for were actually bolstered and given prominence by the *unions*. How’s that for irony?)

1954 – Disability benefits included in social security coverage for the first time

1965 – Medicare and Medicaid created – private sources still paid 75% of all of the health care costs.

1995 – individuals and companies pay for about half of the health care with the government responsible for the other half.

1980 – 1990 – the cost of health care increases and the employer-sponsored group insurance plans switchfrom “fee-for-service” plans to cheaper “managed care plans.” by the mid 90’s most Americans with health insurance were enrolled in managed care plans.

The problem with the so-called “public” option is that the government is not on a level playing field with private firms.
Um, huh? Firms with a history of dropping coverage when people get sick and denying coverage of life-saving procedures deserve a level playing field? How about providing a level playing field for all Americans regardless of financial or employment situation when it comes to healthcare? I don’t see how the health of Aetna’s stock is more important than the health of a human being.

@GregLondon Actually, I don’t recall saying at any time that the free market would produce a perfect solution to this problem. There is no perfect system. And the free market is no more fragile than any of our other freedoms, which can easily be squashed by the brute force of government. This is like saying that people are fragile because if you drop a piano on them, they die. Well, no kidding. And if the free market couldn’t “handle anything that was laissez faire” then the portions of our economy that are still relatively laissez faire would have been failing for quite some time. This isn’t about whether or not a public option CAN co-exist with private health insurance, of course that’s possible. But why, when a cheaper option open to all exists, would employers consider paying the higher cost of their current health care plans?

The bottom line for me in this whole discussion is this: there’s jack shit that I can do to prevent any of this legislation from going through so we’ll see what happens. I seriously doubt that a few angry people at some town hall meetings are going to affect this process. And I doubt that these people have the power to completely shut down a national debate. Guess what? Obama can go on prime time network television and address the american people anytime he wants. If he really wanted to have a national discussion on this issue there’s a pretty simple way to start one: put a few smart people on both sides of this issue in a room and have a televised discussion.

I can think of a couple of “relatively laissez faire” things that have been failing for quite some time. They’ve been in the news a lot lately.

Research the skyrocketing insurance costs- see how many times health insurance has been raised on the employer during this past decade- and then see if you still feel like bemoaning the cheaper, unfair public option for insurance. The non-profit I used to work for went through horrible hair-pulling decisions each year, often switching insurance companies yearly so that the costs wouldn’t increase quite so much and they could still afford something for their employees. It was a given that they’d go up, we just had to shop for the least painful increase. Did the insurance companies’ expenses go up 20% to 100% per year? I think not, yet that’s what we’d see in the way of increases.

I work for a company that can’t afford to insure its employees. There is simply no viable option among the for-profit insurance companies for us. We would have to pay $2400 per month to put our 6 employees on a bare-bones, emergency -only policy. That is about 9% of our monthly gross. We operate on a 2% profit margin. We have three employees other than me (I’m on my husband’s insurance) who work more than 3/4 time and have no insurance. It drives my boss crazy. We want to help our employees, but we can’t and stay in business without making staff cuts, which kind of defeats the “helping our employees” part of the equation. Our employees are not looking for a handout. Just something that is affordable.

The public meetings are not debate forums. They are meetings staged by the Democrats to present their talking points, so no debate is interrupted by the people who are seriously P.O.’d about an incredibly expensive plan that the President was trying to ram through Congress.

If this legislation is so important, why not take some time to craft it and present it to the public in cogent terms? Instead we get a shifting sands approach where the President and Democratic members of Congress keep changing their message trying to find something that the public will respond to. Obama has used fear from the financial crisis to rush his plans through Congress. That’s how we got the Patriot Act and near unanimous congressional support for the war in Iraq after 9/11. We need to slow down this time.

If all these plans are so great, why not use them to fix Medicare, which will soon be broke? Instead we are told that almost half of the money to fund Obama’s plan will come from cuts in Medicare. Any wonder why people don’t believe the President?

If this legislation is so important, why not take some time to craft it and present it to the public in cogent terms?

It would help if public players wouldn’t blatantly lie about the stuff that’s already out there. For example, “cuts” in Medicare are the removal of the 15% subsidy that insurers currently get in order to make it “fair” to them (and “fixing Medicare” does nothing for the currently uninsured or the fact that insurance is tied to employment)(and let’s not get into death panels).

Free market economies don’t magically create good outcomes. What they do make it possible for good outcomes to result from systems that are far too complicated for anyone to create them by fiat.

In a society where stupid choices are routinely made, there will be lots of bad outcomes. That’s the market at work. That’s a feature, not a bug.

Quite a lot of the problems with criticisms of free market ideologies come from people who want the system to be responsible for good outcomes, rather than individual people and their choices. It’s a fundamental difference in the assignment of responsibility, one that leads to a lot of our talking past each other without actually communicating.

To suggest we’re not having a proper debate on health care because some geezers are filling up town halls and occassionally heckling their representatives is laughable.

There is a debate: between a White House that claims reform will cut costs and the CBO which says it will increase costs. There is a debate between a government that says they should have more control over 16% of the economy — kind of like they did with real estate and Fannie/Freddie — and with a majority of Americans who think Pelosi and Reid shouldn’t be trusted with sharp objects.

People are pissed and they have a right to be with this jumble of legislation that few people have read and even fewer understand.

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